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Georgia Insurance Fraud Defense

There are certain crimes that prosecutors are incredibly familiar with, and that they deal with on a daily basis. Generally, however, prosecutors are not adept at navigating a prosecution for Insurance Fraud. Insurance Fraud in Georgia is unique for a variety of reasons. Namely, Georgia Insurance Fraud charges are typically brought after an investigation by the Office of Insurance and Safety Fire Commissioner and not by local law enforcement agencies. 

These investigations include in-depth investigations conducted by trained state-level investigators with the Office of the Insurance Commissioner. A complete defense requires an attorney willing to pay close attention to the detail and will could require consultation with an expert witness or forensic accountant. 

The law is below, but, simply put, insurance fraud occurs when a policy-holder or service provider collects payments that they were not legally entitled to receive.

Georgia Insurance Fraud - The Law

(a)Any natural person who knowingly or willfully:
(1)Makes or aids in the making of any false or fraudulent statement or representation of any material fact or thing:
(A) In any written statement or certificate;
(B) In the filing of a claim;
(C) In the making of an application for a policy of insurance;
(D) In the receiving of such an application for a policy of insurance; or
(E) In the receiving of money for such application for a policy of insurance for the purpose of procuring or attempting to procure the payment of any false or fraudulent claim or other benefit by an insurer;
(2) Receives money for the purpose of purchasing insurance and converts such money to such person's own benefit;
(3) Issues fake or counterfeit insurance policies, certificates of insurance, insurance identification cards, or insurance binders; or
(4) Makes any false or fraudulent representation as to the death or disability of a policy or certificate holder in any written statement or certificate for the purpose of fraudulently obtaining money or benefit from an insurer

commits the crime of insurance fraud.

(b) Any natural person who knowingly and willfully or with reckless disregard engages in the following activities, either directly or indirectly, as an agent for, as a representative of, or on behalf of an insurer not authorized to transact insurance in this state commits the crime of insurance fraud:
(1) Soliciting, negotiating, procuring, or effectuating insurance or annuity contracts or renewals thereof;
(2) Soliciting, negotiating, procuring, or effectuating any contract relating to benefits or services;
(3) Disseminating information as to coverage or rates;
(4) Forwarding applications;
(5) Delivering policies or contracts;
(6) Inspecting or assessing risk;
(7) Fixing of rates;
(8) Investigating or adjusting claims or losses;
(9) Collecting or forwarding of premiums; or
(10) In any other manner representing or assisting such an insurer in the transaction of insurance with respect to subjects of insurance resident, located, or to be performed in this state.
(c) Any natural person who knowingly and willfully with intent to defraud subscribes, makes, or concurs in making any annual or other statement required by law to be filed with the Commissioner containing any material statement which is false commits the crime of insurance fraud.
(d) In any prosecution under this Code section, the crime shall be considered as having been committed in the county of the purported loss, in the county in which the insurer or the insurer's agent received the fraudulent or false claim or application, in the county in which money was received for the fraudulent application, or in any county where any act in furtherance of the criminal scheme was committed.
(e) A natural person convicted of a violation of this Code section shall be guilty of a felony and shall be punished by imprisonment for not less than two nor more than ten years, or by a fine of not more than $10,000.00, or both.
(f) Subsection (b) of this Code section shall not apply to a contract of insurance entered into in accordance with Article 2 of Chapter 5 of this title.

Examples of Insurance Fraud in Georgia

There are several ways that people can be accused of committing insurance fraud. Below are a few examples of allegations that prosecutors may make:

  • Staged slip-and-falls at various businesses.
  • Staged automobile accidents. 
  • Insurers embezzling premiums from clients. 
  • Selling insurance when not licensed to do so. 

Penalties for Committing Insurance Fraud

Georgia's insurance fraud statute provides that someone convicted of a violation faces between two and ten years in prison and a fine of up to $10,000. Additionally, the defendant will likely be subject to paying any restitution that may be owed to the aggrieved party. 

Contact Us - Macon and Newnan Criminal Defense

Contact J. Ryan Brown Law, LLC today so we can combat the charges against you. With offices in Newnan and Macon, we are uniquely situated to provide representation to clients throughout the State of Georgia. Give us a call today and set-up a free consultation with Ryan.